CLEMENTS CUSTOM GUNS ORDER BLANK
DATE ____________
NAME ___________________________________
ADDRESS ___________________________________________
CITY __________________STATE ________ZIP __________
PHONE NO.-HOME _______________WORK _______________
EMAIL _________________________________
SERIAL NO. OF GUN SENT ______________MFG. AND MODEL______________
BARREL LENGTH WANTED ___________________FINISH __________
INSTRUCTIONS AND OPTIONS
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AMOUNT OF PAYMENT ENCLOSED ___________________
Complete the blanks below if paying by MC or Visa, debit or credit.
CARD NO. _________________________________________
EXPIRATION DATE _______________3 digit security code on back of card ___________
NAME ON CARD ____________________________________
ZIP CODE OF BILLING ADDRESS ______________________
UPS & USPS shipping address:Clements Custom
2766 Mt. Zion Road
Woodlawn,Va. 24381
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